Dwyer-Lindgren Laura, Bertozzi-Villa Amelia, Stubbs Rebecca W, Morozoff Chloe, Shirude Shreya, Unützer Jürgen, Naghavi Mohsen, Mokdad Ali H, Murray Christopher J L
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.
JAMA. 2018 Mar 13;319(10):1013-1023. doi: 10.1001/jama.2018.0900.
Substance use disorders, including alcohol use disorders and drug use disorders, and intentional injuries, including self-harm and interpersonal violence, are important causes of early death and disability in the United States.
To estimate age-standardized mortality rates by county from alcohol use disorders, drug use disorders, self-harm, and interpersonal violence in the United States.
Validated small-area estimation models were applied to deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 for alcohol use disorders, drug use disorders, self-harm, and interpersonal violence.
County of residence.
Age-standardized mortality rates by US county (N = 3110), year, sex, and cause.
Between 1980 and 2014, there were 2 848 768 deaths due to substance use disorders and intentional injuries recorded in the United States. Mortality rates from alcohol use disorders (n = 256 432), drug use disorders (n = 542 501), self-harm (n = 1 289 086), and interpersonal violence (n = 760 749) varied widely among counties. Mortality rates decreased for alcohol use disorders, self-harm, and interpersonal violence at the national level between 1980 and 2014; however, over the same period, the percentage of counties in which mortality rates increased for these causes was 65.4% for alcohol use disorders, 74.6% for self-harm, and 6.6% for interpersonal violence. Mortality rates from drug use disorders increased nationally and in every county between 1980 and 2014, but the relative increase varied from 8.2% to 8369.7%. Relative and absolute geographic inequalities in mortality, as measured by comparing the 90th and 10th percentile among counties, decreased for alcohol use disorders and interpersonal violence but increased substantially for drug use disorders and self-harm between 1980 and 2014.
Mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence varied widely among US counties, both in terms of levels of mortality and trends. These estimates may be useful to inform efforts to target prevention, diagnosis, and treatment to improve health and reduce inequalities.
物质使用障碍，包括酒精使用障碍和药物使用障碍，以及故意伤害，包括自残和人际暴力，是美国过早死亡和残疾的重要原因。
估计美国各县酒精使用障碍、药物使用障碍、自残和人际暴力的年龄标准化死亡率。
将经过验证的小区域估计模型应用于国家卫生统计中心（NCHS）的去识别化死亡记录以及美国人口普查局、NCHS和人类死亡率数据库的人口计数，以估计1980年至2014年各县酒精使用障碍、药物使用障碍、自残和人际暴力的死亡率。
居住县。
美国各县（N = 3110）按年份、性别和死因划分的年龄标准化死亡率。
1980年至2014年期间，美国记录了2848768例因物质使用障碍和故意伤害导致的死亡。酒精使用障碍（n = 256432）、药物使用障碍（n = 542501）、自残（n = 1289086）和人际暴力（n = 760749）的死亡率在各县之间差异很大。1980年至2014年期间，酒精使用障碍、自残和人际暴力的全国死亡率有所下降；然而，在同一时期，这些原因导致死亡率上升的县的比例，酒精使用障碍为65.4%，自残为74.6%，人际暴力为6.6%。1980年至2014年期间，药物使用障碍的全国死亡率和各县死亡率均有所上升，但相对增幅从8.2%到8369.7%不等。通过比较各县第90百分位数和第10百分位数来衡量的死亡率的相对和绝对地理不平等，酒精使用障碍和人际暴力有所下降，但药物使用障碍和自残在1980年至2014年期间大幅增加。
酒精使用障碍、药物使用障碍、自残和人际暴力导致的死亡率在美国各县之间差异很大，无论是在死亡率水平还是趋势方面。这些估计可能有助于为旨在进行预防、诊断和治疗以改善健康和减少不平等的努力提供信息。
